Cost-effectiveness of installing barriers at bridge and cliff sites for suicide prevention in Australia

Importance: Installation of barriers has been shown to reduce suicides. To our knowledge, no studies have evaluated the cost-effectiveness of installing barriers at multiple bridge and cliff sites where suicides are known to occur. Objective: To examine the cost-effectiveness of installing barriers at bridge and cliff sites throughout Australia. Design, Setting, and Participants: This economic evaluation used an economic model to examine the costs, costs saved, and reductions in suicides if barriers were installed across identified bridge and cliff sites over 5 and 10 years. Specific and accessible bridge and cliff sites across Australia that reported 2 or more suicides over a 5-year period were identified for analysis. A partial societal perspective (including intervention costs and monetary value associated with preventing suicide deaths) was adopted in the development of the model. Interventions: Barriers installed at bridge and cliff sites. Main Outcomes and Measures: Primary outcome was return on investment (ROI) comparing cost savings with intervention costs. Secondary outcomes included incremental cost-effectiveness ratio (ICER), comprising the difference in costs between installation of barriers and no installation of barriers divided by the difference in reduction of suicide cases. Uncertainty and sensitivity analyses were undertaken to examine the association of changes in suicide rates with barrier installation, adjustments to the value of statistical life, and changes in maintenance costs of barriers. Results: A total of 7 bridges and 19 cliff sites were included in the model. If barriers were installed at bridge sites, an estimated US $145 million (95$90 to $160 million) could be saved in prevented suicides over 5 years, and US$270 million (95% UI, $176 to$298 million) over 10 years. The estimated ROI ratio for building barriers over 10 years at bridges was 2.4 (95% UI, 1.5 to 2.7); the results for cliff sites were not significant (ROI, 2.0; 95% UI, -1.1 to 3.8). The ICER indicated monetary savings due to averted suicides over the intervention cost for bridges, although evidence for similar savings was not significant for cliffs. Results were robust in all sensitivity analyses except when the value of statistical life-year over 5 or 10 years only was used. Conclusions and Relevance: In an economic analysis, barriers were a cost-effective suicide prevention intervention at bridge sites. Further research is required for cliff sites

The cost of fall-related injuries among older people in NSW, 2006-07

This study aimed to establish comprehensive estimates of the cost of fall-related injury among older people in NSW. A health service utilisation approach was used to estimate the cost of hospital treatment, residential care and ambulance transport. Other costs were estimated by deriving ratios of inpatient costs to other services from the literature. In the 2006-07 financial year, 251,000 (27%) of older people fell at least once and suffered, in total, an estimated 507,000 falls. An estimated 143000 medically treated fall-related injuries among older people resulted in lifetime treatment costs of $558.5 million. Although only 18% of these injuries resulted in hospital admission, the cost of care associated with these cases accounted for 84.5% of the total cost. The cost of fall-related injury among older people in NSW in 2006-07 is a significant increase over earlier estimates and underscores the urgent need for effective preventive efforts across the state.5 page(s

Characteristics of suicide decedents with no federally funded mental health service contact in the 12 months before death in a population-based sample of Australians 45 years of age and over

Introduction: More than half of suicide decedents have no contact with mental health services 12 months before death. It is uncertain if they have different characteristics than decedents who use mental health services. Methods: A case-series design. Participants 45 years and older, who died by suicide (2006–2018). Comparisons were made between those who did and did not have contact with mental health services, using individually linked data from federal services in the Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS). Results: Of 186 cases, 71% had no contact with mental health services. Physical health services were used equally by 75%. Psychiatric medication use was uncommon, except for antidepressants, 50% with mental health service contact and 20% with no contact. Older age, lower income, involuntarily unemployed, firearms as suicide method, greater physical disability, less functional impairment due to emotional problems and lesser proportions with mental illness, were associated with no contact with mental health services. Conclusions: For suicide prevention, middle-older aged adults may have less requirement for mental health intervention, and greater requirement for the development of complementary interventions focused on physical health and social issues, which are not necessarily best delivered by clinical mental health services

Descriptive, univariate, and multivariate results for individual characteristics of those who died by suicide involving road vehicle collision and other methods between 2001 and 2017 in Australia.

Descriptive, univariate, and multivariate results for individual characteristics of those who died by suicide involving road vehicle collision and other methods between 2001 and 2017 in Australia.</p

Proportion of travel modes used and collision counterparts for different types of road vehicle collision as a suicide method between 2001 and 2017 in Australia.

Proportion of travel modes used and collision counterparts for different types of road vehicle collision as a suicide method between 2001 and 2017 in Australia.</p

Suicide rates involving other methods between 2001 and 2017 in Australia.

Suicide rates involving other methods between 2001 and 2017 in Australia.</p

Incidence rate ratios for deaths by suicide involving road vehicle collision and other methods.

Incidence rate ratios for deaths by suicide involving road vehicle collision and other methods.</p

Suicide rates involving road vehicle collision between 2001 and 2017 in Australia.

Suicide rates involving road vehicle collision between 2001 and 2017 in Australia.</p

Trends in the leading causes of injury mortality, Australia, Canada and the United States, 2000-2014

OBJECTIVES: The aim of this study was to highlight the differences in injury rates between populations through a descriptive epidemiological study of population-level trends in injury mortality for the high-income countries of Australia, Canada and the United States. METHODS: Mortality data were available for the US from 2000 to 2014, and for Canada and Australia from 2000 to 2012. Injury causes were defined using the International Classification of Diseases, Tenth Revision external cause codes, and were grouped into major causes. Rates were direct-method age-adjusted using the US 2000 projected population as the standard age distribution. RESULTS: US motor vehicle injury mortality rates declined from 2000 to 2014 but remained markedly higher than those of Australia or Canada. In all three countries, fall injury mortality rates increased from 2000 to 2014. US homicide mortality rates declined, but remained higher than those of Australia and Canada. While the US had the lowest suicide rate in 2000, it increased by 24% during 2000-2014, and by 2012 was about 14% higher than that in Australia and Canada. The poisoning mortality rate in the US increased dramatically from 2000 to 2014. CONCLUSION: Results show marked differences and striking similarities in injury mortality between the countries and within countries over time. The observed trends differed by injury cause category. The substantial differences in injury rates between similarly resourced populations raises important questions about the role of societal-level factors as underlying causes of the differential distribution of injury in our communities